COVID-19 Science Table Guidance
On November 24 the Ontario Science Table released guidance on the use of monoclonal antibodies to treat patients with COVID-19.
The guidance relevant to primary care is seen in box 2 below:
Mildly Ill Patients: Patients who do not require new or additional supplemental oxygen from their baseline status, intravenous fluids, or other physiological support. These patients are usually managed in an ambulatory/outpatient setting.
For your information also (although this group would not normally be managed in primary care):
Moderately Ill Patients: Patients newly requiring low-flow supplemental oxygen. These patients are usually managed in hospital wards.
Hamilton is the first pilot site for outpatient administration of monocolonal antibodies in Canada, led by Dr Zain Chagla.
Rationale for pilot:
The COVID-19 pandemic has caused significant healthcare strain globally, and vaccinations have largely helped in significant reductions. However, there remains patients who are unvaccinated and poorly vaccinated due to immunity issues (2). Monoclonal antibodies have shown promise in high risk populations in preventing hospitalization by up to 70-80%:
Absolute difference found in RCTs in high risk populations compared to placebo was 3.3% (1.3% vs 4.6%) REGEN-COV study and 6% in a sotrovimab study (1% vs 7%)(1,3) and severe outcomes (Absolute risk difference in mortality in seronegative subgroup of hospitalized patients 1% (2% vs 1%) (4) in a study of REGEN-COV.)
However much of the data is from prior to large scale vaccinations, and the emergence of the delta variant.
While promising, implementation strategies remain difficult, and investments into healthcare infrastructure may are difficult during periods of increased strain. These drugs have largely not been used in Canada as part of the COVID-19 response but are now recognized globally as the standard of care for COVID-19 early and late disease (5). There remains a paucity of literature of real-world implementation particularly in the Canadian context, as well trying to implement these drugs in a largely vaccinated cohort, particularly with the delta variant.
How to refer:
As part of a feasibility study, Hamilton will become the first pilot site for the outpatient administration of these drugs. Patients will be brought to St. Joseph’s Healthcare Charlton if they meet indications for therapy and have a symptom onset of < 7 days.
The referral letter indicates those at highest clinical risk – both vaccinated or unvaccinated. Please fax in referrals promptly and patients will be contacted for a clinic appointment, 7 days a week. (fax number is on the bottom of the form)